04 December, 2011

There are good reasons why I have not contributed anything to this blog for more than five years. Incredibly enough, other chapters are close to being ready for publication, and have been for some time. The "investigating suicides" blog has pertinaciously refused to write itself, and somehow I have not been able to bring myself to finish and post any of the others until winning the battle against that refusal.

It is a tough one, my friends. While all discussions of death are difficult for many on some level, in this one, I'm going to discuss a manner of death that is unique to all others, and it is the one death topic most avoided. No one wants to talk about, read about, hear about, or think about suicide, yet it is probably the most important to contemplate. And I'm not going to address physician-assisted, Hemlock Society, or any other terminally ill patient suicide. This blog is about the decisions of persons in emotional despair choosing to end their lives.

It is the one we control the most. The definitions of suicide include "the action of killing one's self intentionally; self-murder; self-destruction; the taking of one's own life." Among the most interesting I found, however, is "to make away with one's self." While this last one almost reads as an absurdly comical description of a complex, sorrowful act, it also communicates something greater to me than simply ending one's life with intent; it is indicative of deliberate removal of one's self from others, permanently.

I was astounded at the number of suicides reported to the Delaware County Medical Examiner's Office. Suddenly, as an intern in training and then a full-time investigator, a paradigm shift became necessary. Why? Here are some of the suicide "facts" we are taught in Western culture:

I will share what I observed anecdotally, backed up by some statistical research. Readers should bear in mind that my direct observational experience occurred between ten and fifteen years ago.

First of all, there are certainly depressed, lonely people who find the winter holidays unbearable and choose that time to end their lives, but this is not the time period when suicide rates trend upward - in fact, they drop. Rather, spring and fall tend to be far higher. What sense does this make, one might wonder? I am not formally trained in psychology, but my thoughts are that with the emergence of spring, there is a natural renewal of hope, and this often does not leave a place for someone who feels hopeless. As for fall, perhaps it's similar to spring in that it perpetuates a feeling of change. Or did Dylan Thomas express it best in his "rage, rage against the dying of the light" phrase - only in a literal sense (and in direct contrast to the poem's meaning)? I don't know the answers. I do know that Christmas was pretty slow for suicides when I worked as an investigator. Perhaps it is more difficult to remove one's life from others when more people are around, as they tend to be during holidays.

As for teen suicide, I don't have much investigative experience with this, fortunately. Not that suicide in any age group is easy to handle, but there is something especially heart-wrenching about a person that age giving up his or her life. The recently launched "It Gets Better" campaign comes to mind; often, life really does get better - or has the capacity to - but during the teen years, it is all too easy to feel that despair is the norm. I remember this well. I do recall the youngest suicide victim to come through our office while I was there. It was not a case I investigated. It was a boy who hanged himself, purportedly because a girl he liked did not share his feelings.

He was twelve.

I think about all of the child and teen bullying stories I read and hear about, in the media and from people I know, and I would like to be able to state with confidence that more awareness exists now than did 10 or 20 years ago. I'm not sure I can. There is more publicity, which creates at least a superficial awareness, and this is an important step. Even more important is to facilitate understanding and support; it seems that to too many of us, it's a problem that exists only for "other people," interestingly enough, much like suicide. "My kid wouldn't get bullied." "My child wouldn't bully another." Well, guess what? It happens, and every child on either side of it belongs to someone, and in a sense, to all of us. And I hear and read about extreme examples where a bullied child or teen does commit suicide. I wonder how many of the suicide victims I palpated for injuries through gloved hands had been tormented as young people? I will never know, but I'm guessing the percentage is high.

So, they all leave notes, right? Of course not. In fact, although our training taught the conservative estimate was that 60% or more do not, current statistical accounts suggest that fewer than 20% of suicide victims actually do leave a note. Living in the times that we do now, I wonder if social media has affected this. It's something to research, perhaps, but again, I don't have the answers. And in most of the suicides I investigated, notes were not found - at least not at the scene.

As an investigator, suicide investigations stayed with me. At face value, they usually appeared to be so preventable, yet often the decedents had seemingly good support systems in their lives. In communicating with the members of these support systems, I began to notice commonalities among the statements:

"He seemed a lot happier lately; I can't believe he did this."

"This is a shock - she was depressed for so long, but really got her act together during the past two weeks."

Interesting that a chronically depressed person who may have even (repeatedly) expressed suicidal ideation might actually present as content, at peace, happy, and even giddy prior to the final act. It makes sense to me; a decision has been made, the person feels a sense of relief, and there is a finite solution to a lifetime of struggles. I am not advocating the decision in the least, but the logic exists. And this does nothing to alleviate the guilt of anyone left behind.

"I should have seen it."

We aren't mind readers, even of those to whom we are closest. We hide things from those we love, for our protection and for theirs, and they do likewise. It is our nature. By all means, those cries for help we are taught to recognize are of critical importance, but it is not realistic to expect to identify each and every one of them. The guilt that exists is a fallacy. We, as humans reacting to suicide, focus so much on the aftermath of an individual situation that we fail to see a collective. And we have to do better, which means having real dialogue about suicide as a society.

Since leaving my forensics career, I've been able to step back and make some personal observations about suicide in American society.

First of all, suicide is treated as a dirty secret. I'm willing to bet almost everyone has contemplated suicide - perhaps (and hopefully) not considered it as a personal act, but contemplated all the same. I don't think this is alarming or even negative introspection. Most of us make a choice to live, even if that choice isn't conscious or deliberate, but if it is, then we know. We understand, and we choose. I don't know or understand what goes on inside the mind of someone who makes the opposite choice; it's not a choice I can imagine making. Yet, for those who have considered suicide beyond contemplation, it is not something that is socially acceptable to admit. It isn't even "okay" to say "I've thought about this before and decided not to do it." Why is that the case? I suspect it has much to do with how we view and treat mental illness in our society. And, as usual, I have far more questions than answers, but I know in order to address the problem as a country or community or even smaller microcosm, this must change. To understand, help, and heal, candor is required.

I certainly empathize with the other side of this - the guilt, the anger, the resentment, the sadness, and the confusion. Yet, as much as I don't want to know how it feels to be suicidal, I think those of us who aren't have a responsibility to better understand those who are suicidal. I can only speak directly from a place of someone who had a loved one unsuccessfully attempt suicide. The same feelings apply, only in that instance, thankfully, dialogue is possible. I had the opportunity to try to understand, help, and forgive. Even after almost two decades, I'm still working on all of this, but I'm not afraid to try, or to talk about the process from the loved one's side - or any other part of it. If the attempt had been successful, I can only imagine how long it would have taken me to process the anger, sadness, guilt, and regret - probably a lifetime of my own.

Another observation, mentioned earlier, is that we have to keep doing better for our kids. I am not a parent, but am pretty invested in the happiness and health of some children of family and friends. I worry, and while I don't have answers to many of the problems out there, if something worries me, I will speak up. It's essential, and not just because of teen suicide rates, but because we must create healthy, stable adults.

And finally, a suicide trend I've become more recently aware of - and find appalling - involves our veterans. I don't know how many veteran suicides I investigated. The reason I don't know this is sad in itself: we saw a number of cases involving alcohol, prescription and/or illicit drug abuse leading directly to death through overdose, or indirectly through systems failures due to long term abuse. Some of these folks were veterans with chronic physical pain. The pain is initially treated with prescription drugs, and as chemical tolerance builds, the need to find other sources of relief grows. This, in turn, often leads to alcohol and illicit drug use, and the use becomes chronic abuse. The causes of these deaths are generally not challenging to find, however the manners were usually deemed "Undetermined." It's tough to prove suicide in these instances, and our pathologist was not comfortable ruling the manner as "Natural" if an overdose was the primary cause (and I agree with his reasoning).

What we are facing now is this: combat veterans are returning to civilian life. Some are physically injured, but I suspect even greater numbers are living in mental nightmares. From what I've read and been told, civilian life can be challenging enough to re-adapt to, even for a non-combat veteran. Add an injury and/or post-traumatic stress disorder (PTSD) to the mix, and then provide inadequate transitional services, and what do you have? A population of veterans with a tremendous amount of stress - levels and types of stress that most of us cannot comprehend. We absolutely must provide better assistance for these veterans, because some of them are certainly turning to substance abuse, while still others are opting for more drastic acts of self-violence. I've observed the wake of one example of this, and it is heart-rending and far-reaching.

Because this blog has been so difficult to write for so long, I've realized I have been caught up with format as well as content. The format has been to share specific experiences and meaningful insights about my years in forensic investigation. In this entry, I haven't done much of this, and while I know it isn't my best example of writing, I am satisfied with the results. In keeping with the format and theme, however, I will share a case that left a strong and somber impression upon me. It was not in any way a typical suicide; in fact, I'd seen nothing like it before, nor have I since:

The decedent was a woman in her very early 20s and a single mother of a small child. The evening of her death, she left the child with her mother and went to a bar with friends. Upon leaving the bar very late at night (early morning), she was arrested for drunk and disorderly conduct in the parking lot. She was taken into custody, processed, and incarcerated. She asked the police to allow her to call her mother to let her know where she was, and that she would not be home anytime soon to pick up her child. She was denied this request. She was then placed into a holding cell, which consisted of a room with a small barred window on the door and a closed circuit camera in one corner. In other words, for all appearances, a pretty standard arrest and placement into a pretty standard jail cell.

She started out fairly calm, if clearly still somewhat intoxicated. She was certainly lucid enough to speak clearly and emphatically, as she continued to ask to be allowed to call her mother. She talked of nothing but fear for her mother having to go to work in the morning and not knowing what to do with the child, or where her daughter was. Her requests became pleas, and then screams, followed by soft crying and then more begging: "Please, just let me tell my mom where I am. She has my daughter. I have to pick my daughter up in the morning!" There was no response from the officers.

She then took off her sweater and sat in front of the door, still crying and pleading. She wrapped the sweater around the doorknob and wrapped another part of it around her neck, then leaned forward. She was still for what seemed to be an eternity, then kicked, then went limp. Seconds became minutes before officers unlocked the door and found her unresponsive. Her vitals were checked, and no resuscitation efforts were made.

How do I know the intricate details of her death? As part of the investigation, I watched the video of her ending her life in the jail cell - the one the in-house officers either did not watch as it was happening or watched and acted upon far too late.

Cause of death: Hanging

Manner of death: Suicide

We all have our nightmares.

And the insomnia continues.

While I find many sources of insight, encouragement, and stimulation in my life, specific credit and gratitude for this most recent writing inspiration go to Sheri M., Chris P., and Kelly W.C., for reasons they each know.